Healthcare Provider Details

I. General information

NPI: 1285259358
Provider Name (Legal Business Name): STEPHANIE PEARSON GEBHARDT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2020
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALM AVE
JACKSONVILLE FL
32207-8432
US

IV. Provider business mailing address

PO BOX 45278
JACKSONVILLE FL
32232-5278
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-7300
  • Fax: 904-202-7433
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-393-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11007452
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007452
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11007452
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: